Midwifery is catching

For a moment, consider your vagina (or for the menly folk out there, consider your own genitalia but in a different context). Consider what it means to you, and who touches it. Consider the way in which they touch it, ask your permission to get up close and personal with it, worship it and carress it, discover it and explore it. Consider how you were brought up to think about your vagina - a naughty place, a private place, a special place, a great place… the ideas vary.

Think about how it is touched in day to day life. It’s wiped, washed or rinsed, dried, tucked into lacy frilly underwear or something functional, thought about regularly, rarely or never. If hands are near it, it’s often in a sexual manner with lots of connotations of love, passion, caring, friendliness, permission and fun*, and usually because you want it.

*Please keep in mind that I’m not touching on anything other than normal to great touching and views here. Sexual abuse and misuse of vaginas is not what I’m talking about here just yet, ok? Maybe for another day.

There are also no gloves. There may be latex involved, and should be in some cases, but for most stable, longish term relationships, or at least at the baby making phase, there aren’t.

So how then does wearing gloves during vaginal exams as a midwife, change how we view the vagina? I agree that on one hand (ha ha), wearng gloves is of the utmost importance for maintaining ones safety when bodily fluids are around. I’m not debating whether people should glove up before undertaking an exam. What I am debating is how wearing gloves depersonalises the whole process and makes it ok to do things that we wouldn’t even consider doing with a lover, or with our own. 

VEs can hurt like the Hades, and are often of no practical use, though employed for lots of reasons. They are REALLY intrusive as well which isn’t really surprising given that hands are being stuck places. Would we as midwives think differently if our hands were ungloved? Would it be more of a person to person contact, with the attendant asking of permission and respect for surfaces and places, rather than a matter of gloving up, lubing up and progressing? I’m not trying to be crass here but the way that I’ve seen VEs done is truly like that - similar to a dentist gloving up and poking in your mouth.

Student midwives probably need to distance themselves from vaginas because of what we see of them and are asked to do to them. They are the most amazing and mysterious pieces of the body to me, and they are beautiful and lovely. They all vary, and are as individual as faces. I feel it an honour to be invited into the woman’s confidence as she spreads her legs and births a babe into the world. But to see it draped with green sheets, disinfected and probed, detached from the woman it is part of, set aside from the emotion and pain involved in birth, bothers me to the core. To see VEs done "to check progress" when it’s clear that the babe is not being born right this second, and so progress is somewhere less than stage 2, and all that it’s going to do is disappoint the woman and give the midwife something to write on the partogram, makes me so sad.

Perhaps this dehumanisation is part of why c-section rates are sky rocketing. Women can’t cope with the assult on their vagina and go into the fight-or-flight reaction we all have to assults of our person, and labour stalls.

How could you possibly expect any other animal to birth the way we do, under lights, with invasive procedures, monitors, machines that go ping, a revolving door of staff and few familiar faces?

In an amazing reminder that people actually do read this hear blog, I have been nominated as a Blogger for Positive Global Change! Sage Femme, who is one of my idols most read bloggers, said such nice things about me:

Midwifery is Catching: Training in a hospital setting in Australia, but this woman gets it. I hope she is able to further influence autonomous birth within whatever setting she practices in. Check out her knitting on Flickr, too! 

I never really realised/acknowledged that I am going to be "hospital trained". This label really doesn’t sit well with me - I don’t want to be a "medwife" as many hospital trained midwives seem to be, and I want more training that just in the hospital setting. But that’ll come with time.

I get asked quite regularly two things:

"How do you find time to do everything?"

and

"Why do you give so much time to this? Does it mean you have no life?"

which I guess are two opposite ends of the spectrum.

Let me tell you a bit about my life. I have a partner who is the love of my life - we just celebrated 2 years together. I am 27. I live in a house with 3 boys (yes, 3. Menly types. Boys. One fantastically domesticated and supportive (but he’s mine and no he’s not cloneable) and two others), ruled over by the iron paw of my kitty:

 

Let it be known that she got in that box all by herself, and had us nearly in tears with laughter over it. More (142 in total!) photos can be seen on Flickr!

I do lots of things with my time. I knit. I paint. I sing in a choir. I am on that choir’s committee. I also have a part-time job. Between all of that and a full-time load at school and a lot of antenatal visits, I am busy. But that’s how I like to be. I find time because it’s important to me to find time for everything. I hate getting to the end of the day and thinking "well crap I achieved nothing at all today".

That said, it’s not a case of holding my nose and doing these things. I love what I do (for the most part) and I do what I love (also for the most part - I wish there was more time for knitting and painting). I spend a lot of time with my partner, and a lot of time by myself. I always have time for my women, and love spending time with them. They have their own ring tone in my phone and I am there for them, day and night. 

So what happens when I have an appointment that clashes with something else in my busy life? Well this is where my (seemingly) amazing ability to prioritise comes in. Or maybe it’s where the true realisation of the worth of things comes into being.

• Lecture vs antenatal - no competition.
• Lab or tutorial vs antenatal - harder to say, because these count towards my final mark and while I can miss some, I can’t miss lots. Plus I learn a lot in them…
• Antenatal/postnatal vs knitting - antenatal because knitting is a timeless activity and more to the point, it’ll be there next week.
• Antenatal/postnatal vs work - work, as I still need to earn the bikkies (maybe another day I’ll post about student support here in Oz), although it may in some cases be work because I have a strong work ethic, but those I tend to know about beforehand so can say yay or nay before the day. 
• Antenatal/postnatal Birth vs anything else - in theory, everything is trumped by a birth but sometimes I will have to miss them (and by them, I mean births for the women that I am following through their journey).

Other things have different and fluctuating priorities but I am surprised at the fervour I have about this. It’s easy to prioritise when I am given clear choices. And yes, I do weigh up the pros and cons of things!

With the "life on hold" comments - I wonder about this. Last night I went out with friends for a drink (hush, I know it was a Tuesday but I don’t care!) and it ended up being a late night and I was a little drunk by the end of it. It was only when I got home that I realised if L went into labour and I got a phone call, it would be a late night followed by an early call out, and I would possibly not be in a state to drive safely.

This made me think - should I not go away on holidays, plan anything, drink at all, commit to other commitments, or have a life when someone that I have a quasi-professional relationship with is going to give birth? Does that mean that for a month, I am attached to my phone 24/7 and not able to turn it off to watch a movie or go to a funeral? Do I put my life on hold for the rest of my degree, or do I enjoy the time I have where I am not being *paid* to do that, but when my work ethic says I should?

During the rest of the year, I have plans. I have camps, dinners, quiz nights, carolling, concerts, parties, visits, celebrations, plans and unplans. I have people to visit, books to read, and alcohol to drink. I would be disappointed if I was unable to go to someone’s birth because I’d chosen to do something else, but Murphy’s law applies to midwives as well as anyone else, and so it is said that a watched babe doesn’t arrive, and the minute you turn your back all hell breaks loose.

P.S. A great way to freak ones in-loves out is to decline their invitation to stay for lunch because you have to get back the city for an antenatal appointment! I need to use the word "clinic" instead me thinks .  

Ok so it’s a slow night for blog titles. Do you have any idea how hard it is to come up with them sometimes?? And it’s mid-July here which is also mid WINTER and I had a t-shirt on all day (with jeans and shoes mind you).

It’s now week 1 of Semester 2 (well, actually, Study Period 5 but I am old fashioned and think in semesters still!) and at day 3 I am thinking "woh what am I in for this semester???". The work is a lot more mature, grown up, challenging and titilating. I am doing biology, cultural studies (much focused on non-dominant cultures in Australia, so a lot of Aboriginal aspects but also other non-dominant cultures), health care for women and families, and more normal pregnancy and childbirth. I have 3 weeks of placements this semester, which is not too many given that I also have to work!

The best piece of news I have to share with you is that I got Very Good Marks for first semester - 2 HDs (over 85%) and a D (75-84%). Considering that my first semester had a few challenges (read: accidents, broken bones, trips to hospital etc) I am really proud of myself for working hard to get those marks. I’m not sure I can do it again this semester, but I sure will try.

I have had one of my follow-through women give birth (story to follow at some point), and have picked up two more women, so I have updated my totals. Progress is being made, plans are being hatched, and I am loving spending time with my women. They are all so different! One of my women is at the pointy end of things today, and I wanted to share a little about today’s fun and exciting antenatal visit with you.

I turned up early on my gorgeous new scooter and got a very nice park thankyouverymuch! I was early but that was ok, as I had my shawl to keep me company. My woman turned up a little late which was fine as the clinic was running pretty late, and we chatted for a while. I gifted her a lovely pendant with lots of good birthing wishes in it, and we were eventually called into the room.

When I did the blood pressure, things were good. The midwife got me to measure the fundus (how long the bump is) to check my technique. My preferred way is to put 0cm on the symphysis pubis, as this is a fixed point, and then measure up to the top of the uterus. Procedures and preferences vary though, and some midwives are very vocal about their preferred method. Then I had to do an abdominal palpation to find the baby, and where it was lying. All thoughts of "lie", ROA, LOP, breech, cephalic etc went out of my head and poof, I had no idea! I thought I could find a spine (hard bit) on the left, and a squidgy bit (tummy, legs etc) on the right but no head (which at this stage should be engaged somewhere near the top of the pubic bone)… crap. I couldn’t visualise where this babe was, though I knew her to be longitudinal (up and down relative to mum’s body).

I looked like an idiot first year student and the midwife had a feel around as well - and couldn’t find a head either! We were both very confused about this, because the hard thing I thought I could feel could in fact be a head. The midwife asked for the ultrasound, which was applied to find bub with her head firmly in the true pelvis (hence being unable to find it!) and hence unable to be palpated. The hard thing I had felt turned out to be a leg, and the baby’s spine to the mother’s right. All very confusing. And oddly enough, the first guess I made of the lie was LOA and that was correct, though I was saying it for all the wrong reasons .

The only thing that I was surprised by today was the midwife insisting that L book in for an induction now. She is not yet even 39 weeks! I was taken aback and while I can understand the hospital wanting to book near-term women in for these things for rooms and times and resourcing, the attitude of "well you’re nearly at term and we won’t let you go more than 40weeks +7 so you Will Be Induced shortly" was a bit much. Given that the dating scan is +/- 7 days, and babies rarely appear on their due date, am I wrong to think this is a little hasty? I was so proud of L though, as she asked me how best to avoid an induction (hoping I’d say castor oil / walking / sex / curry / squatting etc) and instead I said "stay away from the hospital". I would never encourage someone to put themselves or their babe at risk however!

I haven’t as yet written of the births that I’ve attended, but I want to find my voice for writing them. I need to find a line between not sharing them, and betraying confidences. So I’ll start with my first catch - not the first one I attended, but the first time I found out that midwifery is in a tiny part, catching.

The woman was having her 3 baby after 2 children (so we write that as 3:2) and came in with regular contractions after a day of labouring at home. After a few hours, she got to 4cm and stopped. The contractions continued, but from what I noticed, she didn’t like the midwife attending her and so her labour didn’t progress further. When the midwife left the room to call the obstetrician, I sat with the woman and talked about everything and anything that I could think of. Over the next 20 minutes, during which the other midwife left me alone to supervise while she grabbed a short break, the amazing woman went from 4cm to 9cm in several long, bone rattling contractions, with her groaning and moaning loudly. The obstetrician walked in and thanked the woman for waiting for him to arrive - he hadn’t made it for her last baby!

The ob asked me how many deliveries I had made (his words, not mine) and I said, wide eyed that I had none as yet and he said well this wasn’t going to be my first but that I should glove up and catch. And I did! A few minutes later, a wriggling bundle of girl slipped into the world and into my hands. I held her up, teary eyed and awestruck, while the cord was cut, and then handed her to the other midwife for her minstrations.

And so that was my first catch. I remember that I still had my (STUPIDLY WHITE) uniform on, having not had time to change. I remember the smell of amniotic fluid, and the tears in the vagina because the baby’s hand shot out as she was born. I remember the woman’s vagina stretching and stretching and stretching to birth her babe, and the look of absolute love and almost hero worship on the face of her husband as he watched his wife do the most amazing thing ever.

The only drugs used in the making of this was some nitrous oxide, and local anaesthetic for the suturing. That was it. And so my first "catch" was made.